CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Rehabilitation Hospital Springfield
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $101
- Cash Discount Price: $101
- vs. Medicare Baseline: 3.12x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Rehabilitation Hospital Springfield is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.12x the Medicare baseline. Located in 5904 S Southwood Rd, Springfield, MO.
Cash / Self-Pay
$101
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$32.4
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.4 (100%)
Cash / Self-Pay: $101 (312%)
Insurance Median: $101 (312%)
Cash: $101 (312% of Medicare)
Ins. Median: $101 (312% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $32.4 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 312% of the Medicare baseline (a markup of 212%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $44 - $110 | 136% |
| Blue Preferred | $53 - $80 | 164% |
| Firsthealth Network | $54 - $81 | 167% |
| Blue Cross Blue Shield | $56 - $110 | 173% |
| Healthlink Workcomp | $63 - $94 | 194% |
| Allwell From Home State Health | $74 - $110 | 228% |
| Allyalign Health (Nhc Advantage) | $74 - $110 | 228% |
| Ambetter / Centene | $74 - $110 | 228% |
| Architectural Systems, Inc. (Asi) | $74 - $110 | 228% |
| Ava R1 School District (Smbc) | $74 - $110 | 228% |
| Bakersfield School District (Smbc) | $74 - $110 | 228% |
| Blue Access | $74 - $110 | 228% |
| Bolivar School (Smbc) | $74 - $110 | 228% |
| Buchheit | $74 - $110 | 228% |
| Cardinal Scale (Tri State Healthcare Coalition) | $74 - $110 | 228% |
| Carthage R-9 School District (Tri-State Healthcare Coalition) | $74 - $110 | 228% |
| Cigna | $74 - $110 | 228% |
| City Of Springfield | $74 - $110 | 228% |
| City Of Webb City (Tri State Healthcare Coalition) | $74 - $110 | 228% |
| Devoted Healthcare | $74 - $110 | 228% |
| Diversified Plastics | $74 - $110 | 228% |
| Dora School District (Smbc) | $74 - $110 | 228% |
| Easter Seals Midwest | $74 - $110 | 228% |
| Employers Benefit Alliance | $74 - $110 | 228% |
| Essence | $74 - $110 | 228% |
| Evolutions | $74 - $110 | 228% |
| Fabick Cat | $74 - $110 | 228% |
| Fair Grove School District (Smbc) | $74 - $110 | 228% |
| Health Net Federal Services | $74 - $110 | 228% |
| Health Systems, Inc. | $74 - $110 | 228% |
| Healthlink Hmo | $74 - $110 | 228% |
| Healthlink Ppo | $74 - $110 | 228% |
| Heart Of America (Tri State Healthcare Coalition &Amp;#8211; Med Pay) | $74 - $110 | 228% |
| Hickory County Skyline School District (Smbc) | $74 - $110 | 228% |
| Home State Health Plan, Inc. | $74 - $110 | 228% |
| Humana | $74 - $110 | 228% |
| J And M Farms, Inc. (Tri-State Healthcare Coalition) | $74 - $110 | 228% |
| Jayhawk Fine Chemicals/Evonic(Tri State Healthcare Coalition) | $74 - $110 | 228% |
| Laclede County School District Conway (Smbc) | $74 - $110 | 228% |
| Lebanon School District (Smbc) | $74 - $110 | 228% |
| Liberty Utilities (Empire District Electric) | $74 - $110 | 228% |
| Marshfield School District (Smbc) | $74 - $110 | 228% |
| Medica | $74 - $110 | 228% |
| Medicaid / KanCare | $74 - $110 | 228% |
| Mercy Charity Contract | $74 - $110 | 228% |
| Mers Goodwill | $74 - $110 | 228% |
| Missouri State University | $74 - $110 | 228% |
| Mount Vernon School District (Smbc) | $74 - $110 | 228% |
| Mountain Grove R-111 School District (Smbc) | $74 - $110 | 228% |
| Mountain View School District (Smbc) | $74 - $110 | 228% |
| Multiplan/Phcs/Beech Street | $74 - $110 | 228% |
| Ozarks Community Hospital | $74 - $110 | 228% |
| Pathway/Pathway X | $74 - $110 | 228% |
| Phcs Savility | $74 - $110 | 228% |
| Quality Collisson Group | $74 - $110 | 228% |
| Quiktrip Corporation | $74 - $110 | 228% |
| Richards R-V School District (Smbc) | $74 - $110 | 228% |
| Roper Automotive Group (Tri State Healthcare Coalition) | $74 - $110 | 228% |
| S And H Farm Supply | $74 - $110 | 228% |
| Schreiber Foods | $74 - $110 | 228% |
| Shinesolar | $74 - $110 | 228% |
| Springfield Public Schools | $74 - $110 | 228% |
| Springfield Remanufacturing | $74 - $110 | 228% |
| Trailiner | $74 - $110 | 228% |
| UnitedHealthcare | $74 - $110 | 228% |
| Webb City R-Vii School District (Tri-State Healthcare Coalition) | $74 - $110 | 228% |
| Wellcare Health Plans | $74 - $110 | 228% |
| Woodard Cleaning &Amp;#038; Restoration, Inc. | $74 - $110 | 228% |